Helping Patients to Share Missed Medication Doses With Minimal Shame

Mar 07, 2017

“To name an object is to suppress three-quarters of the enjoyment to be found in the poem, which consists in the pleasure of discovering things little by little: suggestion, that is the dream.”

Stephane Mallarme
French Symbolist Poet, Victorian Era

Helping Patients to Share Missed Medication Doses With Minimal Shame

TISA Description of the Problem: We are always looking for ways to help patients more easily express material that is difficult to talk about because it generates shame and/or guilt. The following excellent tip provided by Gerda Van AAlst, M.D. – who was a participant at my advanced clinical interviewing course at the 2007 Annual Meeting of the American Psychiatric Association in San Diego – provides a nice method for helping a patient to more easily share that he or she missed doses of a prescribed medication.

Tip: When asking about missed doses, I often find the following question to be effective. I think it works because it empathizes with the patient’s difficulties or concerns about the medication:

“I know it is hard for you to take these medications, how many of them did you manage to take this past week?”

TISA Follow-up: There is a quiet elegance to this question, that lies behind its effectiveness. I like the way Gerda communicates empathic understanding with the opening phrase, “I know that its very hard for you to take these medications.” In addition, I think the next phrase may hold the real secret to the technique’s effectiveness by the use of the word “manage” which subtly acknowledges the fact the it would be reasonable to find it difficult to take the medication while implying that credit is due for those times when it is taken as recommended. Part of the elegant effectiveness also comes from the way in which Gerda does not ask about a negative (how many doses were missed) but asks instead about a positive (how many were taken).

Obviously this question is useful with many of our psychiatric medications, especially if they have tough side-effects or need to be taken more than once a day. It is also a wonderful question to use with patients coping with AIDS in which the pills are numerous in numbers and sometimes huge in size, making the process of taking them often quite a trial (some patients have to essentially gag them down).

If you want to learn more about the art of talking with patients about their medications in a collaborative fashion, you might enjoy my most recently released book, “Improving Medication Adherence: How to Talk with Patients About Their Medications,” which has over forty different tips such as the one above, with each interviewing tip described and illustrated in detail. I might just have to include Gerda’s tip in the next edition! It was great fun to write and I have found the tips, many provided by participants at my workshops on the subject, to be very powerful in helping to increase my patients interest in taking medications. The publisher is Lippincott Williams and Wilkins and it can be found at most medical bookstores and, of course, on

Tip provided by:

Gerda Van AAlst